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Is this fair to ask of a new RN?

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I'm on an ICU step down floor, we get alot of post CABG from ICU, we get alot of admits from cath lab, and general telly patients. The normal ratio is 6:1!! I just got off orientation, that lasted only 5 weeks. I just showed up one day for work and was assigned 4 pt's! No one evaluated me, or formally asked me how things were going.

I work 7a-7p, and have had 4 pt's on my own 2 times. Both times I've stayed until 9:15pm charting, it's REALLY hard straight out of school. Like I'll get a new admit at 4:30pm...and am expected to do the whole LONG admissions process...which took me 45 mins in the pt's room. I had a pt on TPN...which needed a new bag, pt's who needed Accu checks...and ALL of that was late (TPN LATE...thank God is BS was ok!!).

I feel so overwhelmed....I don't chart on some people until after shift is over. AND there are soooo many things I worry about doing for the 1st time like administering blood products. I'm still nervous calling Dr's. :crying2:

What am I suppose to do? Is it always like this for new RN's? I don't feel like I got enough time on orientation, some people get months and I only got 5 wks because of short staffing.

I think since you are now off orientation they will treat like you like any other nurse. You could always try to ask for more orientation but good luck with that. Hospital nursing is way too chaotic in my opinion. I tried it on med surg and resigned after 2 weeks. I just didn't feel safe. You hear lots of people saying you HAVE to do hospital nursing as a new grad..not true. Ive been a nurse for 6 years now and Ive done office nursing, DD/MR nursing, now case management. I have a lunch hour, can go to Dr appts during my workday, can pee whenever i want to lol......I would NEVER EVER try the hospital again! And no working holidays!

PostOpPrincess, BSN, RN

Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU. Has 19 years experience.

I'm going to give you a big kudos for doing the best you can. Unfortunately, it sounds like trial by fire.

How is your intestinal fortitude? Can you stay the course? Do you think you can stick it out? If so, here are some options: Go to your resource, educator, NM and tell them how you feel. Don't hide your fears. Better to let everyone know you are new and still adjusting than pretending you are "okey-dokey." They've spent a lot of time training you, it would be to their benefit to make sure your transition is a success. Tell them what you think will help.

Tell the strongest nurse you can place your trust in how you feel--find your mentor whether that is your preceptor or another experienced person.

It sounds like your hospital is waaaayyyy behind in the whole "how to retain your new nurses thing." That's just too bad.

But it sounds like you're going through what I went through in my first year. Be patient. Decide what your want way down the road...and decide how you want to get there.

Best wishes,

J

nurse2033, MSN, RN

Specializes in ER, ICU.

Welcome to the jungle! Sounds like a typical nursing day. Your day will feel better as each minor task you perform becomes more automatic. Right now you are in conscious competence which takes a lot of brain power. Over the next few months you will gain unconscious competence freeing your brain up. As for not getting enough orientation, if you think so- it is so. However your employer is probably comfortable with where you're at. This is normal, it's a tough job. Do your best and always watch out for safety. Keep looking for ways to chart as you go to save time at the end. Make sure to decompress and relax when you're off. Don't be afraid to a doctor, your job is patient safety, not doctor satisfaction, they get a lot of money to answer your call. If you don't- try the SBAR format (situation, background, assesment, request). This will organize your thoughts and tell the doctor why you called and what you think. Good luck!

Sun0408, ASN, RN

Specializes in Trauma Surgical ICU. Has 4 years experience.

Most of what you said is what I and many new grads go through... I really don't think any amount of orientation would 100 percent prepare us for the job of caring for more than 4 or more pts alone.. It is a whole different world doing everything yourself than having your preceptor back you up when you get in a bind..

I can say, that my worst and best learning happened once I was on my own.. I thought I was in jeopardy of losing my license etc... I felt I was not getting everything done and I was forgetting a lot.. Which I was, but with every shift I improved..

Now, I have learned time management and to prioritize. The person that screams the loudest will not get pain meds when I have a bleeding pt next door. Of course I want to be at all places at once, but that is not possible. I do the most important first than go down the list.. I deal with the bleeding pt first, then get the pain meds...

Group as much work for one pt as possible.. Plan your day. When taking report, I highlight what needs to be done on each pt and cross them off as I go. Just remember calling the Dr is part of your job, he/she may not be happy you called but OH WELL... I would rather call when not needed than not call when it was needed..You will get better and learn what is important info to the doctor the more you call.. It takes practice. I bounce things off my charge nurse and other more experienced nurses also.. Ask for there help when you get in a bind.. You are not expected to know everything, you just need to remember to ask when you are not sure..

I warn my charge nurse about a question, I say "stupid question" then fire away.. Of course it's not stupid but it kinda breaks the "oh no, she is asking another question" :)

I wish you luck, don't give up too soon.. This work takes time, gos knows I am still learning everyday but I handle my 7 pts pretty well and soon you will too :)

himilayaneyes

Specializes in Critical Care/Coronary Care Unit,.

You're feelings are completely normal. New grads are expected to leave late from work. Eventually you'll get better at prioritization (everything needs to be done right away to a new grad, you learn differently with time) and learn to delegate to your pcas so that you can have time to do more important things (e.g., you put the patient on the bedpan, tell the pca to get them off so pt can urinate, but you can go pass meds). And since you're off orientation...it seems like they were being nice to you in giving you only 4 patients if nurses are normally assigned 6 patients. You also can't think of your patient load in terms of numbers on a step-down unit. You also have to look at the acuity of the patient. Chances are they aren't giving you the more acutely ill patients right off of orientation. Just remember to ask lots of questions and utilize your resources (e.g., charge nurse, more experienced nurses, policy and procedures manual, buy a critical care reference book and take it to work, internet, etc.). And no it's not fair that you got only 5 weeks of orientation. I rec'd 3 months of orientation for tele and also receiving 3 months orientation for ICU. Your short orientation is all the more reason for you to advocate for yourself by utilizing your resources. You're not expected to know everything. None of us know everything.Once you ge t familiar with your charting system...you'll be zooming through it. It'll all come with time. It takes about a year to feel comfortable (competent) as a nurse. You know...Benner's theory. http://www.sonoma.edu/users/n/nolan/n312/benner.htm Point is...it's normal...it'll get better with time. Hang in there. ;)

P.S. Little tip is to try to chart every free moment that you have, except during lunch break. Lunch break is for your sanity. If you don't take care of yourself, how can you be expected to care for others.

I work on a similar floor - and you're lucky they're only giving you four. On our floor, once nurses are off orientation, they are treated the same as everyone else and can have 6 or 7 patients their first shifts alone. Many nurses have tried to request longer orientations but unfortunately it hasn't worked.

What I have told our new nurses/orientees is a) try to remember the basics about prioritizing. This is a 24 hour job, so maybe you won't get to do all your dressing changes, and it sucks to pass something on but the next nurse will have to do it. b) you're not expected to know what to do in every situation; what you are expected to know is what is normal and what is not. You can always talk to your co-workers and bounce things off of them before paging the MD.

It took almost a year for me to start to feel comfortable in the hospital. There are a lot of things you don't get to see on orientation unfortunately, so there will be times when you have to rely on your coworkers/educators to help you through. Best of luck. Stick it out -- it's worth it :)

Working on an ICU stepdown floor carrying 6-7 patients is NOT safe and 5 weeks of orientation is bare-bones minimum in my book. I DON'T CARE what other people say about "oh, well it's like that at my hospital too, so it's just something you have to grin and bear." The fact is that having 6-7 patients who are that sick (or have the potential to become very sick) isn't safe no matter how you slice it. As nurses, we can't just grin and bear it anymore- even if the majority of nurses survived those kinds of floors unscathed. I mean, how much quality nursing care can one nurse really give to 6 or 7 stepdown patients? We need to fight for safer ratios.

The stepdown unit I did my senior practicum in had a ratio of 1:3 (3 stepdown patients) or 1:4 max (2 stepdown and 2 floor patients)- much more reasonable. I turned down a job for a similar cardiac stepdown floor where my orientation would have been 10 weeks (2.5 months) and I would have had the same number of patients (6-7 ICU stepdown patients) at night (with day/night rotation). I got 4 solid months of orientation in my current ICU position and was required to go to several new grad-specific classes (and I still have classes to complete). I usually have 2 ICU patients and still stay late to finish charting on most nights (ugh!!!):banghead: I also have a day shift schedule and am not required to rotate to nights :yeah: (well, so far, knock on wood :uhoh3:).

sistasoul

Specializes in neuro/ortho med surge 4.

You poor thing!! We all feel like that as new grads. Nursing is a tough job. It does get better though. The workload will seem more doable once you get used to doing things. 5 weeks of orientation is not enough as a new grad. Can your charge nurse help you? I stiil ask my charge nurse questions even though I have been a nurse for 18 months. I only received 3 weeks of orientation as a new grad. I cried a lot but it is now a lot better.

It is scary calling MDs when you are new. I still hate calling certain MDS but it gets easier. In fact, everything is kind of frightening when you are new. It is normal. If you are doing the best you can you should be proud of yourself. It does get better but it just takes time. Find a nurse on the floor that is receptive to new nurses. The charge nurse and nurses with experience will be your salvation. The charge nurse is supposed to be your resource. Utilize him/her. They would rather you go to them then struggle.

Hang in there. Congratulations for landing a job in this economy as a new grad!!!

Working on an ICU stepdown floor carrying 6-7 patients is NOT safe and 5 weeks of orientation is bare-bones minimum in my book. I DON'T CARE what other people say about "oh, well it's like that at my hospital too, so it's just something you have to grin and bear." The fact is that having 6-7 patients who are that sick (or have the potential to become very sick) isn't safe no matter how you slice it. As nurses, we can't just grin and bear it anymore- even if the majority of nurses survived those kinds of floors unscathed. I mean, how much quality nursing care can one nurse really give to 6 or 7 stepdown patients? We need to fight for safer ratios.

The stepdown unit I did my senior practicum in had a ratio of 1:3 (3 stepdown patients) or 1:4 max (2 stepdown and 2 floor patients)- much more reasonable. I turned down a job for a similar cardiac stepdown floor where my orientation would have been 10 weeks (2.5 months) and I would have had the same number of patients (6-7 ICU stepdown patients) at night (with day/night rotation). I got 4 solid months of orientation in my current ICU position and was required to go to several new grad-specific classes (and I still have classes to complete). I usually have 2 ICU patients and still stay late to finish charting on most nights (ugh!!!):banghead: I also have a day shift schedule and am not required to rotate to nights :yeah: (well, so far, knock on wood :uhoh3:).

I'm glad to see I'm not the only one thinking that this is totally not safe! :eek: I was shocked to read about so many new nurses who are in similar positions. The step-down unit at my hospital has a ratio of 1:3 and gives new grads 12 weeks of orientation. Experienced nurses get 6 weeks. Definitely talk to your manager and see if you can get more orientation. Skimping out on your orientation because they are short-staffed is not in the best interest of anyone, especially the patients. The good thing is that time management and feeling comfortable with skills like hanging blood and talking to doctors will get easier with time. We've all been there... that part does get better!

RedhairedNurse, BSN, RN

Specializes in Med Surg, Ortho.

Wow! This makes me realize what a great job I have. I work as a floor nurse on an extremely busy medsurg unit, we get 5-6 pts on average but never more than 6. Our charge nurse does our admissions for us. We have a very supportive environment and I realize this more after reading your post. I'm sorry it's like this for you and I hope it gets better. I had much support when I was a new grad. I believe that working nights is way more appropriate for new grads. It's a slower pace and builds confidence. Good luck and take care because this situation you describe does not sound safe to me.

nyrn5125

Specializes in pcu/stepdown/telemetry.

is it a telemetry floor? because most stepdown is 1:3 or 1:4. assume you are not at a magnet facility. of course each hospitals has different criteria in stepdown. if your hosp allows alines, cvp, pacing pads then 6 pt's is definitely not safe. on our tele we get 8 pt's. days/nights has same ratio. orientation given is a max 12 shift or 4 weeks. if you were having difficulty then the preceptor should have requested a bit longer

NYLady

Specializes in CCU, L&D, Home Care, Research, Holistic. Has 30 years experience.

I'm so sorry. I wish I could help you. For the moment, I would say to use the tips provided that you think will help you and stick it out as long as you can so you will have "put in your time" and can choose a job or a facility that is more to your liking.

Best of luck. You will make it!!!

6 is A LOT for stepdown. are you sure???

I'm on a cardiac stepdown & im a new grad with 8 week orientation. and the ratio is 2:1 or 3:1 normally. 4:1 if they are stable. My usual load consist of 1 vent, a lot of MI, CHF, pneumonia.. yesterday i had someone complaining of chest pain who had a hx of MI, and a vent with multiple stage 4 wounds, PICC lines, multiple IV fluids, foley, flexi seal, NG, 300 lbs, bed ridden... u know the good stuff. i was overwhelmed!!!!

i think it will get better, but ive worked at places where they do unsafe loads.. everyday i felt my heart was tightening up ( i am only 24) and i feel like a heart attack is about to happen... to ME! if you feel like you're having a stroke while you're working, that is not good..

Ruby Vee, BSN

Specializes in CCU, SICU, CVSICU, Precepting & Teaching. Has 40 years experience.

the first year is the worst. if you weren't feeling scared and overwhelmed, i'd be worried about you! you sound pretty normal to me. it'll get better -- one day you'll be going along doing your business and suddenly you'll realize that you get it. everything just clicks. i "got it" well after the one year mark, so keep plugging along. we've all been there.

Yes, I'm sure it's a step down! lol. There aren't usually vent pt's on the floor. We get alot of post CABG from ICU (after they've been there a few days), chest tubes, post cath lab...it is also a telly floor, so there are the generally telly pt's there.

The hospital is a Magnet facility (believe it or not)....

Ambitiouz

Specializes in CCU. Has 2 years experience.

I think since you are now off orientation they will treat like you like any other nurse. You could always try to ask for more orientation but good luck with that. Hospital nursing is way too chaotic in my opinion. I tried it on med surg and resigned after 2 weeks. I just didn't feel safe. You hear lots of people saying you HAVE to do hospital nursing as a new grad..not true. Ive been a nurse for 6 years now and Ive done office nursing, DD/MR nursing, now case management. I have a lunch hour, can go to Dr appts during my workday, can pee whenever i want to lol......I would NEVER EVER try the hospital again! And no working holidays!

I can only hope to get as lucky as you. I am at my first RN job in the ICU, with 12 weeks orientation and for me I felt 16 weeks wouldve been more adequate. I asked for more orientation time when the 12 weeks was up and I wasn't taken seriously. I dont like how I can't go to the bathroom without making another nurse aware that I need to go pee, and I get no official lunch break, so I often go 12 hrs without eating. So my goal is to stick it out for a year at this joint and move on somewhere else. But this year is so hard to stick out. I don't think ICU is for me, and I'm not sure how good or bad 1 yr of ICU is going to look on my resume, but I simply can't fathom working in this environment for 2 years.

Edited by Ambitiouz

NYLady

Specializes in CCU, L&D, Home Care, Research, Holistic. Has 30 years experience.

I can only hope to get as lucky as you. I am at my first RN job in the ICU, with 12 weeks orientation and for me I felt 16 weeks wouldve been more adequate. I asked for more orientation time when the 12 weeks was up and I wasn't taken seriously. I dont like how I can't go to the bathroom without making another nurse aware that I need to go pee, and I get no official lunch break, so I often go 12 hrs without eating. So my goal is to stick it out for a year at this joint and move on somewhere else. But this year is so hard to stick out. I don't think ICU is for me, and I'm not sure how good or bad 1 yr of ICU is going to look on my resume, but I simply can't fathom working in this environment for 2 years.

It does sound like ICU nursing is not for you but right now you are in a perfect position to set yourself up for a great career. One year of ICU nursing will be fine to move on to another job but I would recommend working a little beyond one year since the first three months could be seen as "not counting". One year is a minimum so, if you can possibly stand it, wait until 15 months have passed. You can simply explain that while you could do the job, you just didn't feel it was the best fit for you. Remember not to complain to a new prospective employer about conditions...make it sound like everything was just fine. Jobs are very competitive right now with hundreds of nurses with similar nursing backgrounds applying for positions (piles of hundreds of resumes handed to recruiters at a job fair yesterday in NYC) so the difference may come down to who is a complainer and who is not.

As far as dealing with it while you are there - Bring your lunch and snacks that you can pop in your mouth in a 1 minute break (grapes are good), Protein bars that you can keep in your pocket, etc. Even with my current job (which is in a procedure lab) I never count of getting a lunch break because sometimes it is just too busy in the middle of the day. But my body can't go without food. I also try not to drink alot of water or coffee during the day so it will cut back on the number of times I need to go to the bathroom. In your case I would probably consider using my pee breaks as a full 15 min (with another nurse covering) three times during the day (if that is possible), then, if you get a full lunch break fine, if not you will be tired but you will have eaten a little and gone to the bathroom...something those in another profession just can't appreciate as real problems.